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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Stereotactic iodine-125 brachytherapy in a patient with a pontine ependymoma WHO grade II

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  • Kea Franz - Neurochirurgische Klinik, Goethe Universität, Frankfurt am Main
  • Maximilian Ruge - Klinik für Stereotaxie und funktionelle Neurochirurgie, Universitätsklinikum Köln
  • Volker Seifert - Neurochirurgische Klinik, Goethe Universität, Frankfurt am Main
  • Christian Senft - Neurochirurgische Klinik, Goethe Universität, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 108

doi: 10.3205/15dgnc506, urn:nbn:de:0183-15dgnc5064

Published: June 2, 2015

© 2015 Franz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: We present a patient with a pontine ependymoma who has been treated by stereotactic iodine-125 brachytherapy 9 years ago with an unexpected short-time but a satisfying long-time follow-up.

Method: This 43-year-old patient presented to his oculist with a blurry vision, running eyes and headache. The prescription of glasses only improved the headaches. Further on, he stopped jogging due to an increasing instability and a hemianopia for the left side. The consulted neurologist found additionally a bradydysdiadochokinesia, a paresis of the abducens nerve on the left side and a slight hemiparesis on the right side. An MRI showed a huge inhomogenously enhancing tumor of the pons nearly without perifocal alterations in T2 weighed images.

Results: After biopsy of the lesion showing an ependymoma WHO grade II the patient was treated by a permanent seed implantation with cumulative therapeutic dose of 50 Gy. 2 weeks later he developed an incomplete peripheral facial palsy on both sides. After a short therapy with corticoids which did not really change the symptoms we opted for “wait and see” being aware of the half-life of 125Iodine of 60 days. Improvement was very slowly but 6 months later there was only a slight remnant of the paresis of the abducens nerve and of the hemiparesis. MRI showed a nice reduction of tumor volume. The patient was reintegrated in his professional life. Actually, 9 years later he is in very good condition and there is no sign of recurrence or seeding into other areas of the central nervous system.

Conclusions: In case of a circumscribed lesion of the brain stem the treatment via stereotactic iodine-125 brachytherapy should be taken into consideration.